项五针联合祛痰治呛方穴位贴敷治疗缺血性脑卒中吞咽障碍的临床观察  

Clinical Observation of Five Needles of the Nape Combined with Qutan Zhiqiang Formula Acupoint Application in Treating Dysphagia Due to Ischemic Stroke

作　　者：张运锋[1] 孔艳芳 秦合伟[1] 刘建东 张沛 ZHANG Yunfeng;KONG Yanfang;QIN Hewei;LIU Jiandong;ZHANG Pei(Henan Provincial Hospital of Traditional Chinese Medicine,Zhengzhou 450002,China;Zhumadian Hospital of Traditional Chinese Medicine,Zhumadian 463000,China)

机构地区：[1]河南省中医院,河南郑州450002 [2]驻马店市中医院,河南驻马店463000

出　　处：《中医药信息》2025年第3期68-73,共6页Information on Traditional Chinese Medicine

基　　金：河南省中医学“双一流”创建科学研究专项课题项目(HSRP-DFCTCM-2023-3-27);河南省中医药科学研究专项课题项目(2023ZY2068);河南省中医药拔尖人才培养项目资助项目(2022ZYBJ15)。

摘　　要：目的:观察项五针联合祛痰治呛方穴位贴敷治疗缺血性脑卒中吞咽障碍的临床疗效。方法:选取符合纳入标准缺血性脑卒中吞咽障碍患者180例,依据随机数字表随机分为对照组和观察组,每组各90例。对照组在常规基础治疗基础上给予“项五针”疗法,观察组在对照组治疗基础上给予祛痰治呛方穴位贴敷,3周为1个疗程。分别于治疗前后进行电视X线透视吞咽功能检查(VFSS)、洼田饮水试验(WST),并采用标准吞咽功能评估量表(SSA)评估患者吞咽功能变化情况;采用肌电诱发电位(sEMG)检测评价患者颏下肌群(颈阔肌上方和下颌下方中线左侧)、舌骨下肌群(甲状软骨右侧)平均振幅及时程;神经损伤相关因子检测血清(IGF-1、PAO、H-FABP)水平;根据WST评分的变化情况评价临床疗效。结果:与治疗前比较,两组治疗后VFSS、WST、SSA评分均明显改善(P<0.05),且观察组较对照组改善明显(P<0.05);与治疗前比较,两组治疗后颏下肌群、舌骨下肌群平均振幅和时程均明显改善(P<0.05),且观察组颏下肌群、舌骨下肌群平均振幅和时程较对照组改善明显(P<0.05);与治疗前比较,两组治疗后血清IGF-1、PAO、H-FABP水平均明显改善(P<0.05),且观察组血清IGF-1、PAO、H-FABP水平较对照组改善明显(P<0.05);观察组临床总有效率95.56%(86/90)明显高于对照组82.22%(74/90)(P<0.05)。结论:项五针联合祛痰治呛方穴位贴敷能明显改善缺血性脑卒中吞咽障碍患者颏下肌群、舌骨下肌群的活动度,促进吞咽功能恢复,增强神经损伤的修复作用,两者合用具有联合增效的作用。Objective:To observe the clinical efficacy of Five needles of the nape combined with the Qutan Zhiqiang Formula acupoint application in treating dysphagia due to ischemic stroke.Methods:A total of 180 patients with ischemic stroke-induced dysphagia,meeting the inclusion criteria,were randomly divided into a control group and an observation group,with 90 patients in each group.The control group received standard therapy along with Five needles of the nape,while the observation group received additional acupoint application with Qutan Zhiqiang Formula.Each course lasted three weeks.Swallowing function was assessed before and after treatment using videofluoroscopic swallowing study(VFSS),the Watian drinking water test(WST),and the standardized swallowing assessment(SSA).Surface electromyography(sEMG)was used to evaluate changes in the submental muscle group(left side of the midline below the mandible)and infrahyoid muscle group(right side of the thyroid cartilage)in terms of average amplitude and duration.Serum levels of neural injury-related factors(IGF-1,PAO,H-FABP)were also measured.Clinical efficacy was evaluated based on WST score changes.Results:Compared with pre-treatment values,VFSS,WST,and SSA scores improved significantly in both groups post-treatment(P<0.05),with the observation group showing more pronounced improvement(P<0.05).Average amplitude and duration of the submental and infrahyoid muscle groups were significantly improved in both groups post-treatment(P<0.05),with greater improvement in the observation group(P<0.05).Serum levels of IGF-1,PAO,and H-FABP improved significantly in both groups(P<0.05),with the observation group showing greater improvements(P<0.05).The total clinical efficacy rate in the observation group was 95.56%(86/90),significantly higher than the control group's 82.22%(74/90)(P<0.05).Conclusion:Five needles of the nape combined with the Qutan Zhiqiang Formula acupoint application significantly improves the mobility of the submental and infrahyoid muscle groups in patients with i

关 键 词：缺血性脑卒中 吞咽障碍 项五针 祛痰治呛方 穴位贴敷 

分 类 号：R74[医药卫生—神经病学与精神病学]